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Chapters 13 and 14
Med/Surg Chapter 13/14
| Question | Answer |
|---|---|
| Filtration | movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of the membrane |
| BP is an example of which: filtration, diffusion of osmosis? | Filtration, high hydrostatic pressure and BP can cause edema because water is always filtering out of the capillaries |
| Diffusion | free movement of particles across a permeable membrane from an area of higher concentration to an area of lower concentration |
| Osmosis | movement of water only though a selectively permeable membrane |
| Osmolarity | number of particles in a liter of solution |
| Osmolality | number of particles in a kilogram |
| Average intake of fluid for adult per day | 1500 mL plus 800 mL from food |
| Minimum amount of urine needed to excrete waste | 400-600 mL |
| Aldosterone | reabsorbs water and sodium, increases osmolarity and blood volume. Prevents blood K levels from getting too high |
| ADH | reabsorbs water, decreases blood osmolarity |
| NP | secreted in response to increase BV and BP, releases water and sodium, decreasing osmolarity and blood volume |
| Changes in Dehydration | Cardio- HR increases, peripheral pulses weak and difficult to find, BP decreases, neck veins flat. Resp- increased resp rate. Skin- reduced skin turgor. Neuro- change in mental status, slight fever. Renal- concentrated urine. Weight loss also indicator |
| Interventions in Dehydration | Fall risk, fluid replacement, teach UAP to offer 2-4 ounces of fluid q hour. Administer IV if appropriate |
| Things to asses during rehydration | pulse rate and quality and urine output |
| Changes in fluid overload | Skin- pitting edema, pale, cool skin. Cardio- high HR, bounding pulse, elevated BP, distended veins, weight gain. Resp- high RR, shallow, dyspnea, moist crackles. Neuro- altered LOC, H/A, vision changes, skeletal muscle weakness. GI- high motility |
| Intervention in Fluid overload | Safety, monitor for pulmonary edema, diuretics (furosemide), assess lab findings, fluid and Na restrictions, monitor I/O, check specific gravity, check weight. Tell pt to call Dr. for more than 3 lbs gain in a week, or 1-2 lbs per day |
| Sodium | Norms- 135-145 |
| Hypernatermia Assessment | dry,sticky mucous membranes, flushed skin, firm skin turgor, intense thirst, edema, oli/anuria |
| Hypernatremia intervention | weigh daily, assess degree of edema, measure I/O, assess skin for breakdown, Na restricted diet, hypotonic (0.225 or 0.45 NaCl) IV |
| Hyponatremia assessment | N/V, abd cramps, weight loss, diarrhea, cold clammy skin, decreased skin turgor, shrunken tongue, apprehension, HA, convulsions, confusion, weakness, fatigue, postural hypotension, weak pulse |
| Hyponatremia intervention | provide foods high in Na, administer NS by IV, assess BP frequently |
| Hypokalemia assessment | Thready/rapid/weak pulse, faint heart sounds, decreased BP, skeletal muscle weakness, decreased/absent reflexes, shallow resps, malaise, apathy, lethargy, loss of orientation, anorexia, vomiting, weight loss, GI distention |
| Hypokalemia interventions | stop K wasting diuretics, administer K supplements, monitor pH, monitor pulse/BP/EKG |
| Hyperkalemia assessment | thready/slow pulse, shallow resps, N/V, diarrhea, intestinal colic, irritability, muscle weakness, numbness, flaccid paralysis, tingling, difficulty with phonation/ resps, spiked T wave, decreased BP |
| Hyperkalemia intervention | administer kayexalate, administer/monitor IV infusion of glucose and insulin, control infection, provide adequate cals and carbs, Discontinue IV or oral sources of K. |
| Hypercalcemia assessment | N/V, anorexia, constipation, HA, confusion, lethargy, stupor, decreased muscle tone, deep bone and/or flank pain, positive Trousseau and Chvostek signsNor |
| Hypercalcemia intervention | encourage mobilization, limit vitamin D and Calcium intake, administer diuretics, protect from injury |
| Hypermagnesemia assessment | lethargy, somnolence, confusion, n/v, muscle weakness, depressed reflexes, decreased pulse and resps |
| Hypermagnesemia intervention | withhold magnesium containing foods, increase fluid intake |
| Hypomagnesemia assessment | parasthesias, confusion, hallucinations, convulsions, ataxia, tremors, hyperactive DTR, muscle spasms, flushing of the face, diaphoresis |
| Hypomagnesemia interventions | provide dietary sources of magnesium |
| Norm pH | 7.35-7.45 |
| Norm CO2 | 35-45 |
| Norm Bicarb | 21-28 |
| Metabolic acidosis causes | too much H- breakdown of fatty acids, anaerobic glucose breakdown, excessive intake of acids, starvation, seizures, heavy exercise, fever. Underelimination of H ions- renal failure. Under production of bicarb- renal failure, pancreatitis, liver failure. |
| Lab values of metabolic acidosis | Ph low, Bicarb low, K high |
| Respiratory acidosis causes | Underelimination of H ions- resp depression, inadequate chest expansion |
| Lab values of respirator acidosis | pH low, CO2 high, K high |
| Acidosis S/S | CNS- lower activity. Neuro- hyporeflexia, muscle weakness, paralysis. Cardio- delayed electrical conduction (tall T, widening QRS, prolonged PR), hypoTN, thready pulse. Resp- kussmaul resps (in metabolic). Skin- M(warm, flushed dry), R(pale/cyanotic, dry) |
| Metabolic Alkalosis causes | increase base- increased antacids, blood transfusion, giving bicarb, TPN. Decrease of acid- prolonged vomiting, NG suctioning, hypercortisolism, hyperaldosteronism, thiazide diuretics |
| Lab values of metabolic alkalosis | pH high, Bicarb high, K low |
| Respiratory Alkalosis causes | excessive loss of CO2- hyperventilation (incl. mechanical ventilation), high altitudes, shock |
| lab values of Respiratory alkalosis | pH high, CO2 low, K low |
| Alkalosis S/S | CNS- increased activity, anx, irritable, tetany, seizures, + Chvosteks, + trouseaus, parathesias. Neuro- hyperreflexia, muscle cramping, weakness. Heart- increased HR, norm/low BP, increased dig tox. Resp- ^ rate/depth in resp, dec. resp effort in met. |
| pH: 7.50 Paco2: 29 mm Hg HCO3-: 24 mm Hg | Respiratory Alkalosis. (pH High, CO2 low) |
| pH: 7.25 Paco2: 61 mm Hg HCO3-: 26 mm Hg | Respiratory acidosis. (pH low, CO2 high) |
| pH: 7.15 Paco2: 30 mm Hg HCO3-: 10 mm Hg | Metabolic acidosis with partial resp. compensation. (pH low, CO2 low, Bicarb low... pH and Bicarb follow the pattern, CO2 doesn't so it's compensation) |
| pH: 7.49 Paco2: 40 mm Hg HCO3-: 29 mm Hg | Metabolic alkalosis (pH high, Bicarb high) |
Created by:
rwrigh17
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